The sixth family are the DPP-4
inhibitors; the gliptins.
So, here's how this works.
Glucagon is a hormone that increases
glucose production in the liver, okay?
Your pancreas puts out
both glucagon and insulin,
so if that was not really familiar to you,
make sure you write yourself a note,
"Pancreas secretes glucagon and insulin.”
They do opposite things.
Remember, insulin takes glucose
out of the blood stream,
puts it in the cells so blood sugar lowers.
Glucagon's job is to stimulate
glucose production from the liver,
so your blood sugar will rise.
We're talking about the gliptins, and
sitagliptin is the one we're looking at.
Now, incretins are hormones that stimulate the
release of insulin when glucose is present.
So, incretins are the hormones,
they're the messengers,
that when your blood sugar is
rising and there's glucose present,
it will suppress glucagon because,
hey, when my blood sugar is rising,
I don't need the liver to make any more sugar.
So, your blood sugar will be lowered.
DPP-4 is a hormone that inactivates incretin,
so your blood sugar level will be lower,
maybe even normal, but
it will definitely be lower.
Now, that may have seemed like a
lot of a process to go through.
So, what I want you to do is to pause the video,
and walk back through your pictures
till you're sure that you're clear
on this mechanism of action.
Back with us?
So, DPP-4 inhibitors block
the breakdown of incretin,
they increase the release of insulin, and
they suppress the release of glucagon.
That's why your blood sugar is lower because
it blocks the incretin from being broken down,
that way, I have more insulin available,
that'll lower my blood sugar,
and less glucagon that will
also cause a lower blood sugar.
So, this improves your A1C, your
hemoglobin A1C, by about 0.5%,
so that might be really helpful,
depending on where your patient is.
So, don't think that's not good enough.
That's really kind of helpful to drop that
A1C by 0.5% just by adding a medication.
So, we might give this medication in monotherapy,
by itself, or we might give it in combination.
Okay, we put a giant pancreas with the big
triangle in it to remind you that this drug,
the gliptins, can have a rare
side effect of pancreatitis.
So, particularly, sitagliptin,
can have this rare side effect.
I know that it's rare, but because it
can end up being life-threatening,
I wanted to make sure you
brought this to your attention.
So, it can range from mild,
which mild pancreatitis is really
uncomfortable for your patient,
but it could progress to life-threatening,
so it's really important that you recognize
the early signs and symptoms of pancreatitis,
so you can teach your patients.
Early signs would be intractable nausea,
that means I have some pretty severe
nausea that doesn't seem to resolve.
They have severe abdominal pain,
they could have some vomiting.
This is when they need to contact their
healthcare provider immediately,
and not take an additional
dose of the medication.